Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy
CPT4 code
Name of the Procedure:
Bilateral Salpingo-Oophorectomy with Total Omentectomy, Total Abdominal Hysterectomy for Malignancy
Summary
This surgical procedure involves the removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy), the omentum (total omentectomy), and the uterus (total abdominal hysterectomy) to treat malignant conditions like ovarian or uterine cancer.
Purpose
The procedure aims to remove cancerous tissues and prevent the spread of malignancy. By eliminating these organs and structures, the chances of cancer recurrence are reduced, potentially improving the patient's prognosis and survival rate.
Indications
- Diagnosed ovarian, uterine, or fallopian tube cancer
- Complex ovarian cysts or masses suspected of being malignant
- Herd the patient with inherited genetic mutations (e.g., BRCA1, BRCA2) increasing the risk of ovarian and uterine cancer
Preparation
- Patients may need to fast for 8-12 hours before surgery.
- Pre-operative blood tests, imaging (ultrasound, CT scan), and possibly a biopsy.
- Patients should discuss current medications with their physician; some may need to be adjusted or discontinued.
Procedure Description
- Administer general anesthesia to ensure the patient is unconscious and pain-free.
- Make an incision in the lower abdomen to access the pelvic and abdominal cavity.
- Identify and carefully remove both ovaries and fallopian tubes first.
- Excise the omentum, a fatty layer covering abdominal organs.
- Remove the uterus, including the cervix, via a total abdominal hysterectomy.
- Ensure all cancerous tissues are removed, and close the incision with sutures or staples.
- Apply sterile dressings to the surgical site.
Duration
The procedure usually takes between 3-5 hours, depending on the complexity and extent of cancer spread.
Setting
Typically performed in a hospital's surgical suite or an advanced surgical center.
Personnel
- Lead Surgeon (Gynecologic Oncologist)
- Surgical Assistants
- Anesthesiologist
- Scrub Nurses
- Circulating Nurses
Risks and Complications
- Common risks: Bleeding, infection, blood clots
- Rare risks: Injury to nearby organs (bladder, bowel), anastomotic leaks, lymphedema
- Long-term risks: Premature menopause, hormonal imbalances, infertility
Benefits
- Removal of cancerous tissues
- Reduced risk of cancer recurrence or metastasis
- Potential for improved survival rates and overall prognosis
Recovery
- Hospital stay: Typically 3-7 days
- Full recovery: 6-8 weeks
- Post-operative care: pain management, wound care, gradually increasing physical activity
- Follow-up appointments for monitoring and additional treatment if necessary (e.g., chemotherapy, radiation)
Alternatives
- Chemotherapy or radiation therapy alone, though less effective for certain stages of cancer
- Hormonal therapy for specific types of cancer with hormone receptor positivity
- Minimally invasive laparoscopic or robotic surgeries, though not always suitable for larger or more complex tumors
Patient Experience
- During the procedure: Completely asleep and unaware due to general anesthesia
- After the procedure: Initial pain and discomfort managed with medication, gradual return to normal activities over weeks
- Emotional and psychological support, as it can be a significant and life-altering surgery